In hindsight,
the argument about Obamacare death panels should defer to the fact that they already existed, the question is do you want insurance adjusters on your panel, or doctors?
My recollection is something about in the UK where they won’t spend a million pounds to do a 90 year old can live to 90.001.
If that’s the case, insurance companies are not death panels. They don’t make determinations about the value of life. They refuse to cover ineffective treatments, but they don’t make evaluations based on age or quality of life.
The fact that something like 80% of health care spending occurs in the last six months of life was something being talked about. Still is.
“Death panel” is an inflammatory word, and nobody is going to acknowledge running one. But I really don’t see how insurance companies can pushed into the definition.
https://www.propublica.org/article/cigna-pxdx-medical-health...
> Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files. “We literally click and submit,” one former company doctor said. <rubber stamping computer algorithm's initial approval or denials>
https://www.propublica.org/article/how-to-appeal-insurance-d...
> It’s especially complicated in oncology, said Dr. Barbara McAneny, a former president of the American Medical Association who runs a 6,000-patient oncology practice in Albuquerque, New Mexico.
> McAneny told me she spends $350,000 a year on a designated team of denial fighters whose sole job is to request prior authorization for cancer care — an average 67 requests per day — and then appeal the denials.
> For starters, she said bluntly, “we know everything is going to get denied.” It’s almost a given, she said, that the insurer will lose the first batch of records. “We often have to send records two or three times before they finally admit they actually received them. … They play all of these kinds of delaying games.”
> Her theory is that insurance companies save money by delaying spending as long as possible, especially if the patient or the doctor gives up on the appeal, or the patient’s condition rapidly declines in the absence of treatment.
> For an insurance company, she said, “you know, death is cheaper than chemotherapy.”
And yes, it's far better for triage to be done by trained medical people than by insurance adjusters. But if given the option, I'd prefer just me and my loved ones making medical decisions about me. Of course we don't have this option, but it should still be something to strive for.
But, in a system with limited resources, it makes not sense to have individuals that need the resources (but don't pay them) making the decisions. Clearly, nearly _everyone_ would say to use every possible medical option on themselves and their loved ones; even if doing so cost other people (with more established and inexpensive treatments) their lives.
For any system where lots of people pay in, and everyone shares the resources, the decisions on how the resources are distributed _must_ be made by something other than individuals in the group that need them.
Actually it might be nice if all such decisions were made by a panel of people from just such a group. Regular people may prioritize some classes of people over others, but are probably less likely to than an elite panel.
Oh, certainly; though I'd argue they should have input from medical and financial experts, too. But regardless...
> just me and my loved ones making medical decisions about me
The decisions made by only the person needing treatment (and their loved ones) is definitely going to result in the resources being bled dry way too quickly.
Private markets are run by contract and have at least minimal check via the court system via lawsuits
Government actors are immune from all liability, and can not be sued unless the government gives you permission to sue them
So do i want insurance death panels.... no. But I would prefer them over government death panels
For the federal government there are a variety of federal statutes that govern various contractual obligations, and provide means to sue.
Press F for Doubt
You are misunderstanding and wrongly extrapolating qualified immunity. Ready any newspaper and you will encounter multiple counterexamples to your statement. Please at least read the wikipedia entry. Here's a start:
"Qualified immunity applies only to government officials in civil litigation, and does not protect the government itself from suits arising from officials' actions.[4]"
no, I am talking about sovereign immunity, which has nothing to do with qualified immunity, and is absolute.
you can not sue the government unless the government has passed a law under which they have allowed you to sue them.
Under the Federal Tort Claims Act, you can sue the federal government if:
You were harmed by a federal employee
The employee was acting within their official duties when the harm occurred
The employee acted intentionally or negligently in a way that caused the harm
You experienced actual damages as a result of the employee’s action
Source and Further reading: https://www.forbes.com/advisor/legal/personal-injury/can-you...
the Federal Tort Claims Act is the federal government waiving their immunity under limited cases.
None of the claims allowed by the Federal Tort Claims act would allow you to sue a federal single payer health system for denial of care that was part of offical policy, or procedure.
The government has no more concern for your well being than the insurance company, the government has the ability to simply create more money out of nothing. They do not need nor care about your taxes, your taxes is just a method of control and to provide some manner of legitimacy to their system on control.
First, you're missing the point that any private company is financially incentivized to end care. Their interests are the polar opposite of yours. Whereas government programs aren't rewarded at all for saving money. (E.g. Social Security doesn't "forget" to mail you checks 10% of the time, the way private reimbursement programs intentionally will. The IRS doesn't tack on surprise extra fees each year, the way your telecoms provider does in total violation of the "fixed price guarantee" they promised.)
And second, you're wrong about the ability to sue the government. There's no meaningful difference in being able to sue a company or sue the government. It's all the same court system. But in either case, if you're relying on suing them in an end-of-life situation, you'll almost surely be dead by the time a court hears the case and decides. So I wouldn't advise making that your deciding factor.
to believe that the government and worse agents with in the government has no financial incentive is crazy. It is absolutely the case that where are tons of both corrupt, and non-corrupt financial incentives with in the realm of public finance. Take a look at school funding, police funding, or the big one Military funding. This idea that medicine would be immune does not match reality even if we limit it to say medicare, or even COVID ...
your view that government only acts in "the best interest of he citizen" is also ignorant of history, in reality it is often the exact opposite, The nine most terrifying words in the English language are: I'm from the Government, and I'm here to help.
Government is not the solution to our problem, government is the problem
>>you're completely wrong about the ability to sue the government. There's no meaningful difference in being able to sue a company or sue the government. It's all the same court system.
No, I am not [1][2][3]. Both the federal and state government enjoy complete immunity from liability unless they agree to be sued,it was not until 1946 that you could sue the federal government at all, with the passage ot the Federal Tort Claims Act[4] the federal government graciously allows us mere mortals the ability to sue them in rare and limited circumstances but that authorization can be removed at any time, and often has been, and I have no reason to believe that congress would allow a single payer system to be sued for denial of care generally
[1] https://www.law.cornell.edu/wex/sovereign_immunity
[2] https://en.wikipedia.org/wiki/Sovereign_immunity_in_the_Unit...
[3] https://law.justia.com/constitution/us/amendment-11/01-state...
Please don't be insulting, it's against HN guidelines.
> your view that government only acts in "the best interest of he citizen"
I didn't say that anywhere, please don't put words in my mouth.
> The nine most terrifying words in the English language are: I'm from the Government, and I'm here to help.
That's a conservative shibboleth. It's been completely and utterly discredited by the accomplishments of Medicare, Medicaid, or Social Security, the ACA. Or of federal disaster response, or of lifting children out of poverty. Etc. Government isn't perfect by any means, but it helps citizens on a massive scale, and thank goodness for that.
> with the passage ot the Federal Tort Claims Act
Right, this allows citizens to sue. Contrary to what you claimed. The fact that the government could undo the act doesn't mean it's not currently the law. You might as well claim you don't have to pay taxes because the government might undo the IRS.
I would not consider any of those programs a success, Social Security is going bankrupt and combined with the national debt pose a HUGE economic problem for the US over the next decade or 2
Medicare/Medicaid only survives by providers over charging private parties to make up for the terrible reimbursement rates to providers, in sort most workers in the US are charged 2x for medicare, once as a payroll tax, and then again by massive insurance premiums to subsidize medicare/Medicaid
ACA I am still amazed at the mental gymnastics that the court used to rationalized that as constitutional at all, but aside from that there is very little to be proud of in that law, it was designed to make insurance more expensive and less responsive as a prelude to Single Payer. The designers of it wanted to collapse insurance to make Single payer the only viable option.
>>Right, this allows citizens to sue. Contrary to what you claimed.
Incorrect again, I clearly stated that the government has immunity unless it allows you to sue them, nothing in the Federal Tort Claims Act would allow for a tort claim for what we are discussing here, the Federal Tort Claims Act has a very narrow and limited circumstance where it can be used to file a case against the federal government
Funny how conservatives have been saying that for many decades now. Everyone was yelling about it back at the start of the 1980's, how it would never make it to the year 2000.
Yet... it hasn't gone bankrupt yet, and indeed shows zero signs of doing so. And indeed, pretty much all developed democracies manage something like it, and it goes just fine. And the debt continues to be a perfectly manageable amount relative to GDP, which is the only thing that actually matters.
And the ACA has been a godsend to many people I know, people who otherwise couldn't get private health insurance at all. There's an incredible amount to be proud of. Not to mention the ACA has worked to rein in health care costs, not increase them -- though sadly it hasn't been able to do enough.
>>all developed democracies manage something like it, and it goes just fine. And the debt continues to be a perfectly manageable amount relative to GDP, which is the only thing that actually matters.
Soo we do not have an economic crisis, high inflation, housing prices out of control, and various other economic problems? or do you believe all of that is disconnected from government spending?
Government needs to spend more to solve those problems? is that your solution/?